1
|
An evaluation of the Index4 tool for chemotherapy toxicity prediction in cancer patients older than 70 years old. Sci Rep 2023; 13:1082. [PMID: 36658198 PMCID: PMC9852555 DOI: 10.1038/s41598-023-28309-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Chemotherapy, although beneficial for improving outcomes in both localized and metastatic cancers, may be associated with significant adverse effects, especially for patients with decreased functional reserves. Prediction of patients who will not tolerate well chemotherapy treatment may help in modifying treatment plans and in reallocating resources to vulnerable patients. One hundred seventeen consecutive cancer patients over the age of 70 scheduled for chemotherapy treatment in a single cancer center were included in the study. Prediction of adverse chemotherapy outcomes were calculated using a prediction tool proposed and validated from the Cancer and Aging Research Group (CARG) and a prediction tool proposed by us, called Index4. The 2 tools were compared for their ability to predict grade 3 and 4 toxicities, Emergency Department (ED) and hospital admissions and chemotherapy discontinuation. The accuracy of both predictive tools was suboptimal. A high CARG score had a sensitivity of 46.3% and a specificity of 82% and an Index4 of 1 or above had a sensitivity of 53.7% and a specificity of 60% in predicting grade 3-4 adverse effects. The performance of the 2 tools in predicting ED and hospital admissions and chemotherapy discontinuation was comparable. An Index4 score of 0 was superior in predicting absence of grade 3-4 toxicities than a low CARG score (p = 0.002, McNemar's test). The CARG tool for chemotherapy adverse effect prediction in geriatric cancer patients and the Index4 were able to predict adverse outcomes with moderate accuracy. Given its ease of calculation Index4 may be an alternative to CARG tool, suitable for a busy oncology practice.
Collapse
|
2
|
García-Sánchez J, Mafla-España MA, Torregrosa MD, Cauli O. Androstenedione and Follicle-Stimulating Hormone Concentration Predict the Progression of Frailty Syndrome at One Year Follow-Up in Patients with Localized Breast Cancer Treated with Aromatase Inhibitors. Biomedicines 2022; 10:biomedicines10071634. [PMID: 35884939 PMCID: PMC9312841 DOI: 10.3390/biomedicines10071634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The standard treatment in postmenopausal women with estrogen- and progesterone-positive localized breast cancer consists of aromatase inhibitors (AROi). The ability of AROi to promote or worsen frailty syndrome over time and the relationship with changes in gonadal hormones concentration in blood have not been investigated. Methods: A prospective study to evaluate the relationship between frailty syndrome and gonadal hormones concentrations in blood at baseline (prior to AROi treatment) and after 6 and 12 months under AROi treatment in post-menopausal women with breast cancer. Frailty syndrome was evaluated by the Fried’ criteria. We evaluated whether hormone concentration at baseline could predict frailty syndrome at follow-up. Results: Multinomial regression analysis showed that of the different hormones, those significantly (p < 0.05) associated to the worsening of frailty syndrome were high androstenedione levels and low follicle-stimulating hormone (FSH) levels in blood. Receiver operating characteristic curve analysis showed both androstenedione and FSH significantly (p < 0.05) discriminate patients who developed or presented worsening of frailty syndrome over time, with acceptable sensitivity (approximately 80% in both cases) but low specificity (40%). Conclusion: Hormonal concentrations before AROi treatment constitute possible biomarkers to predict the progression of frailty syndrome.
Collapse
Affiliation(s)
- Javier García-Sánchez
- Medical Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (J.G.-S.); (M.D.T.)
- Medical Oncology Department, Hospital Center of Wallonie Picardy, 7500 Tournai, Belgium
| | - Mayra Alejandra Mafla-España
- Frailty Research Organized Group, University of Valencia, 46010 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
| | - María Dolores Torregrosa
- Medical Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (J.G.-S.); (M.D.T.)
| | - Omar Cauli
- Frailty Research Organized Group, University of Valencia, 46010 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| |
Collapse
|
3
|
Comparison of Survival Analysis After Surgery for Colorectal Cancer in Above 80 Years (Oldest-Old) and Below 80 Years Old Patients. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
4
|
McGovern J, Dolan RD, Horgan PG, Laird BJ, McMillan DC. The prevalence and prognostic value of frailty screening measures in patients undergoing surgery for colorectal cancer: observations from a systematic review. BMC Geriatr 2022; 22:260. [PMID: 35351011 PMCID: PMC8962494 DOI: 10.1186/s12877-022-02928-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/11/2022] [Indexed: 02/08/2023] Open
Abstract
Introduction Frailty is a complex multifactorial syndrome characterised by a significant increase in vulnerability and worsened health outcomes. Despite a range of proposed frailty screening measures, the prevalence and prognostic value of frailty in patients undergoing surgery for colorectal cancer is not clear. Aim The aim of this present review was to examine the use of commonly employed frailty screening measures in patients undergoing surgery for colorectal cancer. Methods A systematic search of PubMed and Medline was carried out to identify studies reporting the use of frailty screening tools or measures in patients undergoing surgery for colorectal cancer. The screening measure used and prevalence of frailty within the population were recorded. Outcomes of interest were the incidence of post-operative complications, 30-day mortality and overall survival. Results Of the 15 studies included (n = 97, 898 patients), 9 studies were retrospective and included patients aged 70 years or older (n = 96, 120 patients). 5 of 12 studies reported that frailty was independently associated with the incidence of post-operative complications. There was also evidence that frailty was independently associated with 30-day mortality (1 of 4 studies, n = 9, 252 patients) and long-term survival (2 of 3 studies, n = 1, 420 patients). Conclusions Frailty was common in patients with colorectal cancer and the assessment of frailty may have prognostic value in patients undergoing surgery. However, the basis of the relationship between frailty and post-operative outcomes is not clear and merits further study.
Collapse
Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Barry J Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| |
Collapse
|
5
|
Striefler JK, Schmiester M, Brandes F, Dörr A, Pahl S, Kaul D, Rau D, Dobrindt EM, Koulaxouzidis G, Bullinger L, Märdian S, Flörcken A. Comorbidities rather than older age define outcome in adult patients with tumors of the Ewing sarcoma family. Cancer Med 2022; 11:3213-3225. [PMID: 35297222 PMCID: PMC9468425 DOI: 10.1002/cam4.4688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ewing family of tumors (EFT) is rarely diagnosed in patients (pts) over the age of 18 years (years), and data on the clinical course and the outcome of adult EFT pts is sparse. Methods In this retrospective analysis, we summarize our experience with adult EFT pts. From 2002 to 2020, we identified 71 pts of whom 58 were evaluable for the final analysis. Results Median age was 31 years (18–90 years). Pts presented with skeletal (n = 26), and extra‐skeletal primary disease (n =32). Tumor size was ≥8 cm in 20 pts and 19 pts were metastasized at first diagnosis. Between the age groups (≤25 vs. 26–40 vs. ≥41 years) we observed differences of Charlson comorbidity index (CCI), tumor origin, as well as type and number of therapy cycles. Overall, median overall survival (OS) was 79 months (95% confidence interval, CI; 28.5–131.4 months), and median progression‐free survival (PFS) 34 months (95% CI; 21.4–45.8 months). We observed a poorer outcome (OS, PFS) in older pts. This could be in part due to differences in treatment intensity and the CCI (<3 vs. ≥3; hazard ratio, HR 0.334, 95% CI 0.15–0.72, p = 0.006). In addition, tumor stage had a significant impact on PFS (localized vs. metastasized stage: HR 0.403, 95% CI 0.18–0.87, p = 0.021). Conclusions Our data confirms the feasibility of intensive treatment regimens in adult EFT pts. While in our cohort outcome was influenced by age, due to differences in treatment intensity, CCI, and tumor stage, larger studies are warranted to further explore optimized treatment protocols in adult EFT pts.
Collapse
Affiliation(s)
- Jana Käthe Striefler
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Hematology, Oncology, and Tumor Immunology, Berlin Institute of Health, Berlin, Germany
| | - Maren Schmiester
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Hematology, Oncology, and Tumor Immunology, Berlin Institute of Health, Berlin, Germany
| | - Franziska Brandes
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Hematology, Oncology, and Tumor Immunology, Berlin Institute of Health, Berlin, Germany
| | - Anne Dörr
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Hematology, Oncology, and Tumor Immunology, Berlin Institute of Health, Berlin, Germany
| | - Stefan Pahl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Institute of Pathology, Campus Mitte, Berlin Institute of Health, Berlin, Germany
| | - David Kaul
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Radiation Oncology, Campus Virchow-Klinikum, Berlin Institute of Health, Berlin, Germany
| | - Daniel Rau
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Centre for Musculoskeletal Surgery, Campus Virchow-Klinikum, Berlin Institute of Health, Berlin, Germany
| | - Eva-Maria Dobrindt
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Surgery, Campus Virchow-Klinikum, Berlin Institute of Health, Berlin, Germany
| | - Georgios Koulaxouzidis
- Department of Plastic, Aesthetic and Reconstructive Surgery, Congregational Hospital Linz, Sisters of Mercy, Linz, Austria
| | - Lars Bullinger
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Hematology, Oncology, and Tumor Immunology, Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), partner site Berlin, Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sven Märdian
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Centre for Musculoskeletal Surgery, Campus Virchow-Klinikum, Berlin Institute of Health, Berlin, Germany
| | - Anne Flörcken
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Hematology, Oncology, and Tumor Immunology, Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), partner site Berlin, Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
6
|
Hope A, Verduin M, Dilling TJ, Choudhury A, Fijten R, Wee L, Aerts HJWL, El Naqa I, Mitchell R, Vooijs M, Dekker A, de Ruysscher D, Traverso A. Artificial Intelligence Applications to Improve the Treatment of Locally Advanced Non-Small Cell Lung Cancers. Cancers (Basel) 2021; 13:2382. [PMID: 34069307 PMCID: PMC8156328 DOI: 10.3390/cancers13102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
Locally advanced non-small cell lung cancer patients represent around one third of newly diagnosed lung cancer patients. There remains a large unmet need to find treatment strategies that can improve the survival of these patients while minimizing therapeutical side effects. Increasing the availability of patients' data (imaging, electronic health records, patients' reported outcomes, and genomics) will enable the application of AI algorithms to improve therapy selections. In this review, we discuss how artificial intelligence (AI) can be integral to improving clinical decision support systems. To realize this, a roadmap for AI must be defined. We define six milestones involving a broad spectrum of stakeholders, from physicians to patients, that we feel are necessary for an optimal transition of AI into the clinic.
Collapse
Affiliation(s)
- Andrew Hope
- Department of Radiation Oncology, University of Toronto, Toronto, ON 5MT 1P5, Canada;
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON 5MT 1P5, Canada
| | - Maikel Verduin
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Ananya Choudhury
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Rianne Fijten
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Leonard Wee
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Hugo JWL Aerts
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA 02115, USA;
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
- Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, 6228 ET Maastricht, The Netherlands
| | - Issam El Naqa
- Department of Machine Learning, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (I.E.N.); (R.M.)
| | - Ross Mitchell
- Department of Machine Learning, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (I.E.N.); (R.M.)
| | - Marc Vooijs
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Andre Dekker
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Dirk de Ruysscher
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Alberto Traverso
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| |
Collapse
|
7
|
Tarchand GR, Morrison V, Klein MA, Watkins E. Use of Comprehensive Geriatric Assessment in Oncology Patients to Guide Treatment Decisions and Predict Chemotherapy Toxicity. Fed Pract 2021; 38:S22-S28. [PMID: 34177238 DOI: 10.12788/fp.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose Our objective was to review the utility of pretreatment comprehensive geriatric assessment (CGA) and its impact on decision making regarding choice and intensity of oncologic therapeutic regimens for older, frail, or poor-functional-status patients, as well as using this prospective assessment to predict chemotherapy-related toxicities. Database searches were conducted in Medline, PubMed, and Ovid for clinical studies, review articles, and journal publications. Search terms included geriatric assessment, medical oncology, chemotherapy, frailty, toxicity, and functional status. Thirty-seven pertinent articles were retrieved and serve as the basis for this clinical review. Observations CGA is an important tool for examining aspects of frailty and functional status that are not captured by traditional performance status measures. These findings may then be used in selection of appropriate therapeutic regimens for a given patient that are efficacious and tolerable. Such pretreatment assessments also have been used in predicting therapy-related toxicities. Conclusions Frail and older patients are common in oncology practices and are at high risk for therapy-related toxicities because of comorbidities and physiologic changes, presenting a considerable clinical challenge. CGA establishes evidence-based strategies to better assess the functional status of such patients and is predictive for chemotherapy-related toxicities in this vulnerable group. Despite publications on these measures in the oncology literature, there is limited evidence-based research to demonstrate the utility of CGA by practicing oncology providers and how to implement it into practice.
Collapse
Affiliation(s)
- Gobind R Tarchand
- is a Physician Assistant, and is a Medical Oncologist, both in the Hematology-Oncology Section, Primary Care Service Line at the Minneapolis VA Health Care System in Minnesota. is Professor of Medicine in Medical Oncology and Infectious Diseases, and Mark Klein is Associate Professor of Medicine, both in the Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota in Minneapolis. is Associate Professor for the Lynchburg DMSc program at the University of Lynchburg in Virginia. Vicki Morrison is a Geriatric Oncologist in the Division of Hematology/Oncology, Department of Medicine at Hennepin County Medical Center in Minneapolis, Minnesota
| | - Vicki Morrison
- is a Physician Assistant, and is a Medical Oncologist, both in the Hematology-Oncology Section, Primary Care Service Line at the Minneapolis VA Health Care System in Minnesota. is Professor of Medicine in Medical Oncology and Infectious Diseases, and Mark Klein is Associate Professor of Medicine, both in the Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota in Minneapolis. is Associate Professor for the Lynchburg DMSc program at the University of Lynchburg in Virginia. Vicki Morrison is a Geriatric Oncologist in the Division of Hematology/Oncology, Department of Medicine at Hennepin County Medical Center in Minneapolis, Minnesota
| | - Mark A Klein
- is a Physician Assistant, and is a Medical Oncologist, both in the Hematology-Oncology Section, Primary Care Service Line at the Minneapolis VA Health Care System in Minnesota. is Professor of Medicine in Medical Oncology and Infectious Diseases, and Mark Klein is Associate Professor of Medicine, both in the Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota in Minneapolis. is Associate Professor for the Lynchburg DMSc program at the University of Lynchburg in Virginia. Vicki Morrison is a Geriatric Oncologist in the Division of Hematology/Oncology, Department of Medicine at Hennepin County Medical Center in Minneapolis, Minnesota
| | - Elyse Watkins
- is a Physician Assistant, and is a Medical Oncologist, both in the Hematology-Oncology Section, Primary Care Service Line at the Minneapolis VA Health Care System in Minnesota. is Professor of Medicine in Medical Oncology and Infectious Diseases, and Mark Klein is Associate Professor of Medicine, both in the Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota in Minneapolis. is Associate Professor for the Lynchburg DMSc program at the University of Lynchburg in Virginia. Vicki Morrison is a Geriatric Oncologist in the Division of Hematology/Oncology, Department of Medicine at Hennepin County Medical Center in Minneapolis, Minnesota
| |
Collapse
|
8
|
Ospina NS, Papaleontiou M. Thyroid Nodule Evaluation and Management in Older Adults: A Review of Practical Considerations for Clinical Endocrinologists. Endocr Pract 2021; 27:261-268. [PMID: 33588062 PMCID: PMC8092332 DOI: 10.1016/j.eprac.2021.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Contextualizing the evaluation of older adults with thyroid nodules is necessary to fully understand which management strategy is the most appropriate. Our goal was to summarize available clinical evidence to provide guidance in the care of older adults with thyroid nodules and highlight special considerations for thyroid nodule evaluation and management in this population. METHODS We conducted a literature search of PubMed and Ovid MEDLINE from January 2000 to November 2020 to identify relevant peer-reviewed articles published in English. References from the included articles as well as articles identified by the authors were also reviewed. RESULTS The prevalence of thyroid nodules increases with age. Although thyroid nodules in older adults have a lower risk of malignancy, identified cancers are more likely to be of high-risk histology. The goals of thyroid nodule evaluation and the tools used for diagnosis are similar for older and younger patients with thyroid nodules. However, limited evidence exists regarding thyroid nodule evaluation and management to guide personalized decision making in the geriatric population. CONCLUSION Considering patient context is significant in the diagnosis and management of thyroid nodules in older adults. When making management decisions in this population, it is essential to carefully weigh the risks and benefits of thyroid nodule diagnosis and treatment, in view of older adults' higher prevalence of high-risk thyroid cancer as well as increased risk for multimorbidity, functional and cognitive decline, and treatment complications.
Collapse
Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida, 32606
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, 48109.
| |
Collapse
|
9
|
Ali J, Sajjad K, Farooqi AR, Aziz MT, Rahat A, Khan S. COVID-19-positive cancer patients undergoing active anticancer treatment: An analysis of clinical features and outcomes. Hematol Oncol Stem Cell Ther 2020; 14:311-317. [PMID: 33387453 PMCID: PMC7759333 DOI: 10.1016/j.hemonc.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/11/2020] [Accepted: 12/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background Cancer patients, particularly those on active anticancer treatment, are reportedly at a high risk of severe coronavirus disease 2019 (COVID-19) infection and death. This study aimed to describe the clinical characteristics and outcomes of patients diagnosed with COVID-19 whilst on anticancer treatment in a developing country. Methods This is a retrospective observational study of all adult cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan, from March 15, 2020 to July 10, 2020, diagnosed with COVID-19 within 4 weeks of receiving anticancer treatment, where a purposive sampling was performed. Cancer patients who did not receive anticancer treatment and clinical or radiological diagnosis of COVID-19 without a positive reverse transcription–polymerase chain reaction (RT-PCR) test were excluded. The primary endpoint was all-cause mortality after 30 days of COVID-19 test. Data was analyzed with SPSS version 23 (SPSS Inc., Chicago, IL, USA). Categorical parameters were computed using chi-square test, keeping p value < 0.05 as significant. Results A total of 201 cancer patients with COVID-19 were analyzed. The median age of patients was 45 (18–78) years. Mild symptoms were present in 162 (80.6%) patients, whereas severe symptoms were present in 39 (19.4%) patients. The risk of death was statistically significant (p < .05) amongst patients with age greater than 50 years, metastatic disease, and ongoing palliative anticancer treatment. Anticancer treatment (chemotherapy, radiotherapy, hormonal therapy, targeted therapy, and surgery) received within preceding 4 weeks had no statistically significant (p > .05) impact on mortality. Conclusions In cancer patients with COVID-19, mortality appears to be principally driven by age, advanced stage of the disease, and palliative intent of cancer treatment. We did not identify evidence that cancer patients on chemotherapy are at significant risk of mortality from COVID-19 correlating to those not on chemotherapy.
Collapse
Affiliation(s)
- Jamshed Ali
- Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Peshawar, Pakistan.
| | - Kashif Sajjad
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Peshawar, Pakistan
| | - Amer Rehman Farooqi
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Peshawar, Pakistan
| | - Muhammad Tahir Aziz
- Department of Pharmacy, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Peshawar, Pakistan
| | - Ayesha Rahat
- Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Peshawar, Pakistan
| | - Sarah Khan
- Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Peshawar, Pakistan
| |
Collapse
|
10
|
Schubert M. Besonderheiten der onkologischen Rehabilitation älterer Patienten. FORUM 2020; 35:460-464. [DOI: 10.1007/s12312-020-00847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
11
|
Care of the Geriatric Colorectal Surgical Patient and Framework for Creating a Geriatric Program: A Compendium From the 2019 American Society of Colon and Rectal Surgeons Annual Meeting. Dis Colon Rectum 2020; 63:1489-1495. [PMID: 32947418 PMCID: PMC7547896 DOI: 10.1097/dcr.0000000000001793] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Supplemental Digital Content is available in the text.
Collapse
|
12
|
Prognostic nutritional index (PNI), independent of frailty is associated with six-month postoperative mortality. J Geriatr Oncol 2020; 11:880-884. [PMID: 32253157 DOI: 10.1016/j.jgo.2020.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/07/2020] [Accepted: 03/26/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Prognostic Nutritional Index (PNI) is associated with disease and overall survival in patients with cancer. We aimed to assess the relationship between PNI, frailty, and six-month postoperative survival in older patients with cancer. METHODS In this retrospective study, patients with cancer aged ≥75 who underwent geriatric preoperative evaluation and then proceeded with elective surgery with hospital length of stay of ≥1 day and had six-month follow-up were included. PNI is measured by preoperative [10 × albumin(gr/dl)] + [0.005 × absolute lymphocyte count (per mm3)]. Higher PNI is suggestive of better nutritional status. Frailty was assessed by geriatric assessment. PNI among patients with and without each age-related impairment was evaluated. Pearson correlation coefficient was used to assess the correlation between the number of age-related impairments and PNI. Multivariable regression analysis was used to assess the relationship between six-month mortality and PNI. RESULTS PNI ranged from 19 to 49 (average 40) among 1025 patients (average age 80). Patients with impairment in Karnofsky Performance Status, falls in the past year, prolonged timed up and go test, limited social activity, significant weight loss, polypharmacy, polycomorbid conditions, depression, and dependent for basic and instrumental activities of daily living had lower PNI than fit patients. The correlation coefficient between PNI and number of aging impairments was -0.28 (p < .001). Each unit increase in PNI was associated with 10% reduction in 6-month mortality (OR = 0.90, p < .001). CONCLUSION PNI independent of frailty, age, American Society of Anesthesiologist Performance Scale (ASA-PS), and metastatic disease is associated with six-month postoperative mortality. Future studies should assess the interventions aimed at improving PNI and its impact on surgical outcomes.
Collapse
|
13
|
Gonçalves SEAB, Ribeiro AAF, Hirose EY, Santos FPDS, Ferreira FM, Koch LDOM, Tanaka M, de Souza MS, Souza PMR, Gonçalves TJM, Pereira AZ. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly. EINSTEIN-SAO PAULO 2019; 17:eAE4340. [PMID: 31116236 PMCID: PMC6533077 DOI: 10.31744/einstein_journal/2019ae4340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly was elaborated by nutritionists, nutrologists and hematologists physicians from 15 Brazilians reference centers in hematopoietic stem cell transplantation, in order to emphasize the importancy of nutritional status and the body composition during the treatment, as well as the main characteristics related to patient's nutritional assessment. Establishing the consensus, we intended to improve and standardize the nutritional therapy during the hematopoietic stem cell transplantation. The Consensus was approved by the Brazilian Society of Bone Marrow Transplantation.
Collapse
Affiliation(s)
| | - Andreza Alice Feitosa Ribeiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Centro de Transplante de Medula Óssea, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Márcia Tanaka
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | | |
Collapse
|
14
|
Le Saux O, Falandry C, Gan HK, You B, Freyer G, Péron J. Changes in the Use of Comprehensive Geriatric Assessment in Clinical Trials for Older Patients with Cancer over Time. Oncologist 2019; 24:1089-1094. [PMID: 30710065 DOI: 10.1634/theoncologist.2018-0493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/03/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The objective of this study was to describe the implementation of comprehensive geriatric assessment (CGA) in clinical trials dedicated to older patients before and after the creation of the International Society of Geriatric Oncology in the early 2000s. SUBJECTS, MATERIALS, AND METHODS All phase I, II, and III trials dedicated to the treatment of cancer among older patients published between 2001 and 2004 and between 2011 and 2014 were reviewed. We considered that a CGA was performed when the authors indicated an intention to do so in the Methods section of the article. We collected each geriatric domain assessed using a validated tool even in the absence of a clear CGA, including nutritional, functional, cognitive, and psychological status, comorbidity, comedication, overmedication, social status and support, and geriatric syndromes. RESULTS A total of 260 clinical trials dedicated to older patients were identified over the two time periods: 27 phase I, 193 phase II, and 40 phase III trials. CGA was used in 9% and 8% of phase II and III trials, respectively; it was never used in phase I trials. Performance status was reported in 67%, 79%, and 75% of phase I, II, and III trials, respectively. Functional assessment was reported in 4%, 11%, and 13% of phase I, II, and III trials, respectively. Between the two time periods, use of CGA increased from 1% to 11% (p = .0051) and assessment of functional status increased from 3% to 14% (p = .0094). CONCLUSION The use of CGA in trials dedicated to older patients increased significantly but remained insufficient. IMPLICATIONS FOR PRACTICE This article identifies the areas in which research efforts should be focused in order to offer physicians well-addressed clinical trials with results that can be extrapolated to daily practice.
Collapse
Affiliation(s)
- Olivia Le Saux
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France
| | - Claire Falandry
- Geriatric Unit, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
- CarMen biomedical research laboratory (Cardiovascular diseases, Metabolism, diabetology and Nutrition) INSERM UMR 1060, Université de Lyon, Oullins, France
| | - Hui K Gan
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- School of Cancer Medicine, La Trobe University, Heidelberg, Australia
- Department of Medicine, Melbourne University, Melbourne, Australia
| | - Benoit You
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France
| | - Gilles Freyer
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France
| | - Julien Péron
- Medical Oncology Department, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- Statistics unit, Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
- CNRS, UMR 5558 Biometry and Evolutionary Biology laboratory Université Lyon 1, Villeurbanne, France
| |
Collapse
|
15
|
Korc-Grodzicki B, Tew W, Hurria A, Yulico H, Lichtman S, Hamlin P, Bosl G. Development of a Geriatric Service in a Cancer Center: Lessons Learned. J Oncol Pract 2018; 13:107-112. [PMID: 28972835 DOI: 10.1200/jop.2016.017590] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Beatriz Korc-Grodzicki
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - William Tew
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Arti Hurria
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Heidi Yulico
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Stuart Lichtman
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Paul Hamlin
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - George Bosl
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| |
Collapse
|
16
|
Sasani K, Catanese HN, Ghods A, Rokni SA, Ghasemzadeh H, Downey RJ, Shahrokni A. Gait speed and survival of older surgical patient with cancer: Prediction after machine learning. J Geriatr Oncol 2018; 10:120-125. [PMID: 30017733 DOI: 10.1016/j.jgo.2018.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/07/2018] [Accepted: 06/27/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Gait speed in older patients with cancer is associated with mortality risk. One approach to assess gait speed is with the 'Timed Up and Go' (TUG) test. We utilized machine learning algorithms to automatically predict the results of the TUG tests and its association with survival, using patient-generated responses. METHODS A decision tree classifier was trained based on functional status data, obtained from preoperative geriatric assessment, and TUG test performance of older patients with cancer. The functional status data were used as input features to the decision tree, and the actual TUG data was used as ground truth labels. The decision tree was constructed to assign each patient to one of three categories: "TUG < 10 s", "TUG ≥ 10 s", and "uncertain." RESULTS In total, 1901 patients (49% women) with a mean age of 80 years were assessed. The most commonly performed operations were urologic, colorectal, and head and neck. The machine learning algorithm identified three features (cane/walker use, ability to walk outside, and ability to perform housework), in predicting TUG results with the decision tree classifier. The overall accuracy, specificity, and sensitivity of the prediction were 78%, 90%, and 66%, respectively. Furthermore, survival rates in each predicted TUG category differed by approximately 1% from the survival rates obtained by categorizing the patients based on their actual TUG results. CONCLUSIONS Machine learning algorithms can accurately predict the gait speed of older patients with cancer, based on their response to questions addressing other aspects of functional status.
Collapse
Affiliation(s)
- Keyvan Sasani
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA
| | - Helen N Catanese
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA
| | - Alireza Ghods
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA
| | - Seyed Ali Rokni
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA
| | - Hassan Ghasemzadeh
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA
| | - Robert J Downey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY 10065, USA
| | - Armin Shahrokni
- Department of Medicine/Geriatrics, Memorial Sloan Kettering Cancer Center, NY, NY 10065, USA.
| |
Collapse
|
17
|
Fakhri B, Fiala MA, Tuchman SA, Wildes TM. Undertreatment of Older Patients With Newly Diagnosed Multiple Myeloma in the Era of Novel Therapies. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2018; 18:219-224. [PMID: 29429818 PMCID: PMC5837946 DOI: 10.1016/j.clml.2018.01.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND With the expanding armamentarium of therapeutic agents for multiple myeloma (MM), it is important to identify any undertreated patient populations to mitigate outcome disparities. MATERIALS AND METHODS We extracted the data for all plasma cell myeloma cases (International Classification of Disease for Oncology, third revision [ICD-O-3] code 9732) in the Surveillance, Epidemiology, End Results (SEER)-Medicare database from 2007 to 2011. The ICD-O-3 histologic code 9732 captures both active MM and smoldering/asymptomatic myeloma. We defined active MM as either claims indicating receipt of treatments approved for MM or ICD-9 codes for MM-defining clinical features, referred to as the CRAB criteria (calcium [elevated], renal failure, anemia, bone lesions). Multivariate logistic regression was performed to determine the variables that were independently associated with receipt of no treatment. RESULTS Of the initial 4187 patients included in the present study, 373 had no claims indicating receipt of treatments approved for MM and had no ICD-9 codes associated with the CRAB criteria and were excluded from the analyses. Of the 3814 patients with active MM, 1445 (38%) did not have any claims confirming that they had received systemic treatment. Older age, poor performance indicators, comorbidities, African-American race, and lower socioeconomic status, including enrollment in Medicaid, were statistically significant factors associated with the receipt of no systemic treatment. CONCLUSIONS In the present retrospective study of data from the SEER-Medicare database, we found that age, health status, race, and socioeconomic status were associated with receipt of MM treatment. These factors have previously been linked to reduced usage of specific treatments for MM, such as stem cell transplantation. To the best of our knowledge, however, ours is the first study to show their association with the receipt of any MM therapy.
Collapse
Affiliation(s)
- Bita Fakhri
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Mark A Fiala
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Sascha A Tuchman
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Tanya M Wildes
- Division of Oncology, Washington University School of Medicine, St. Louis, MO.
| |
Collapse
|
18
|
Characteristics and survival of patients with metachronous or synchronous double primary malignancies: breast and thyroid cancer. Oncotarget 2018; 7:52450-52459. [PMID: 27223440 PMCID: PMC5239566 DOI: 10.18632/oncotarget.9547] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/05/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Clinical experiences suggest that breast cancer (BC) and thyroid cancer (TC) occur metachronously or synchronously in a patient more frequently than it would by chance. This study was conducted to investigate the clinicopathological characteristics and survival of these double primary malignancies. METHODS 18732 patients with first primary BC and 12877 female patients with first primary TC were performed in this retrospective case-controlled study. The control groups were matched with both age at diagnosis and time of surgery (±2 years). The clinicopathological factors, Overall survival (OS), and HRs were evaluated by SPSS. RESULTS There were 91(0.49%) BC patients developed metachronous second primary TC (B-T group), and 117 (0.91%) TC patients developed metachronous second primary BC (T-B group).The expression of estrogen and progesterone receptors, and the value of Ki-67, were significantly higher in the B-T group than control. The median value of thyroid globulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) were higher in T-B group than control (p <0.05). The duration before second primary cancer was shorter for the B-T group than the T-B group (4.09 years vs. 5.82 years, p<0.001). B-T group patients showed poorer survival than BC only patients (p=0.044). CONCLUSIONS In general, the overall risk of the occurrence of a second primary TC or BC elevated highly in patients with BC or TC. Detailed mechanisms need to be studied to explore the association between these two cancers. Early detection and effective prevention for the first primary BC or TC patients are necessities for reducing the incidence of the second primary cancer and improving the OS.
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a practical clinical approach to confusion in the patient with cancer. Confusion in the cancer population has a broader differential diagnosis than in the general medical population. The clinician must consider the usual differential diagnoses as well as causes unique to the cancer patient including direct complications from the cancer and indirect complications related to cancer treatment. RECENT FINDINGS In the recent age of precision medicine, the oncologist now utilizes the genomic profile of both the patient and the tumor to provide advanced biologic therapies including targeted anticancer drugs, antiangiogenic agents, and immunotherapy. Such advances carry with them an emerging pattern of neurotoxicity which, although less well described in the literature, is now an important consideration to the clinical approach to confusion in cancer patients. SUMMARY Confusion is the most common neurologic complication in cancer and is associated with significant morbidity, mortality, and prolonged hospital stays resulting in increased healthcare costs. Early recognition and treatment of delirium is essential to improve clinical outcomes.
Collapse
|
20
|
Dumontier C, Clough-Gorr KM, Silliman RA, Stuck AE, Moser A. Motivation and mortality in older women with early stage breast cancer: A longitudinal study with ten years of follow-up. J Geriatr Oncol 2017; 8:133-139. [PMID: 27986501 PMCID: PMC5373974 DOI: 10.1016/j.jgo.2016.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/11/2016] [Accepted: 12/01/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The Getting Out of Bed Scale (GOB) was validated as a health-related quality of life (HRQoL) variable in older women with early stage breast cancer, suggesting its potential as a concise yet powerful measure of motivation. The aim of our project was to assess the association between GOB and mortality over 10years of follow-up. MATERIALS AND METHODS We studied 660 women ≥65-years old diagnosed with stage I-IIIA primary breast cancer. Data were collected over 10years of follow-up from interviews, medical records, and death indexes. RESULTS Compared to women with lower GOB scores, women with higher GOB had an unadjusted hazard ratio (HR) of all-cause mortality of 0.78 at 5years, 95% confidence interval (CI) (0.52, 1.19) and 0.77 at 10years, 95%CI (0.59, 1.00). These associations diminished after adjusting for age and stage of breast cancer, and further after adjusting for other HRQoL variables including physical function, mental health, emotional health, psychosocial function, and social support. Unadjusted HRs of breast cancer-specific mortality were 0.92, 95%CI (0.49, 1.74), at 5years, and 0.82, 95%CI (0.52, 1.32), at 10years. These associations also decreased in adjusted models. CONCLUSION Women with higher GOB scores had a lower hazard of all-cause mortality in unadjusted analysis. This effect diminished after adjusting for confounding clinical and HRQoL variables. GOB is a measure of motivation that may not be independently associated with cancer mortality, but reflects other HRQoL variables making it a potential outcome to monitor in older patients with cancer.
Collapse
Affiliation(s)
- Clark Dumontier
- Internal Medicine Residency Program, Boston Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, USA
| | - Kerri M Clough-Gorr
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, CH 3012 Bern, Switzerland
| | - Rebecca A Silliman
- Section of Geriatrics, Boston Medical Center/Boston University School of Medicine, 88 East Newton Street, Robinson Building, Boston, MA 02118, USA.
| | - Andreas E Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - André Moser
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, CH 3012 Bern, Switzerland; Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| |
Collapse
|
21
|
Abstract
As the number of older patients with cancer is increasing, oncology disciplines are faced with the challenge of managing patients with multiple chronic conditions who have difficulty maintaining independence, who may have cognitive impairment, and who also may be more vulnerable to adverse outcomes. National and international societies have recommended that all older patients with cancer undergo geriatric assessment (GA) to detect unaddressed problems and introduce interventions to augment functional status to possibly improve patient survival. Several predictive models have been developed, and evidence has shown correlation between information obtained through GA and treatment-related complications. Comprehensive geriatric evaluations and effective interventions on the basis of GA may prove to be challenging for the oncologist because of the lack of the necessary skills, time constraints, and/or limited available resources. In this article, we describe how the Geriatrics Service at Memorial Sloan Kettering Cancer Center approaches an older patient with colon cancer from presentation to the end of life, show the importance of GA at the various stages of cancer treatment, and how predictive models are used to tailor the treatment. The patient's needs and preferences are at the core of the decision-making process. Development of a plan of care should always include the patient's preferences, but it is particularly important in the older patient with cancer because a disease-centered approach may neglect noncancer considerations. We will elaborate on the added value of co-management between the oncologist and a geriatric nurse practitioner and on the feasibility of adapting elements of this model into busy oncology practices.
Collapse
Affiliation(s)
| | - Soo Jung Kim
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | |
Collapse
|
22
|
Schiefen JK, Madsen LT, Dains JE. Instruments That Predict Oncology Treatment Risk in the Senior Population. J Adv Pract Oncol 2017; 8:528-533. [PMID: 30079269 PMCID: PMC6067916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
23
|
Caffo O, Maines F, Rizzo M, Kinspergher S, Veccia A. Metastatic castration-resistant prostate cancer in very elderly patients: challenges and solutions. Clin Interv Aging 2016; 12:19-28. [PMID: 28053513 PMCID: PMC5192056 DOI: 10.2147/cia.s98143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The treatment of elderly patients with cancer is usually viewed by clinicians as a challenge, because of the age-related decline in normal organ function and the frequent concomitant administration of multiple drugs for comorbid conditions. Clinicians therefore tend not to prescribe antineoplastic agents (mainly in the case of chemotherapy) to elderly patients, with the fear of excess toxicity leading to an unfavorable cost:benefit ratio. The cutoff age defining a cancer patient as elderly is usually 70 years, but over the last 10 years clinicians have paid more attention to functional status, as evaluated by means of a comprehensive geriatric assessment and comorbidity burden, rather than chronological age. In the case of metastatic castration-resistant prostate cancer (mCRPC), depending on their age at the time of diagnosis of PC, many (if not most) of the patients are more than 70 years old, and a fair number are very elderly patients aged ≥80 years. The availability of various agents capable of significantly prolonging survival has dramatically changed the therapeutic landscape of mCRPC patients, but very elderly patients are usually underrepresented in pivotal trials. This narrative review considers the available data concerning elderly and very elderly mCRPC patients enrolled in pivotal trials and the information provided by reports of everyday clinical practice, in order to explore the challenges related to the clinical management of this special population.
Collapse
Affiliation(s)
- Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Mimma Rizzo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | | | - Antonello Veccia
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| |
Collapse
|